This is an issue that many F.E.A.S.T. and ATDT Forum Members feel strongly about. Many parents of children suffering from eating disorders feel ignored and/or unsupported when bringing this issue to the attention of their child's school. Schools need to know that weighing a child with an eating disorder is part of that child's treatment protocol and that the "where and when and how often" is a collaborative decision made between parents and the child's clinicians.For those parents who wish to approach and educate their child's school on this issue, here is a sample letter that one of F.E.A.S.T.'s members used to open a dialogue with their child's school.

Dear School Contact,

I have heard that student's height, weight, BMI and fat percentage are being measured in PE classes this year as part of the Fitnessgram program. Although having kids identify and track their BMI may sound like a good idea for promoting health and combating obesity, there is research to suggest that it could in fact do serious harm.

The issue of BMI screening in schools is quite controversial, as there is little evidence of benefit, but the potential for causing unintentional harm, such as exacerbating weight stigma (already fuel for bullying and emotional abuse), and creating extreme anxiety and treatment setbacks for students with eating disorders.

BMI was designed to be a population screening tool, and was never intended to be an individual health assessment tool, as weight is only one factor in an overall health assessment. Furthermore, single BMI data points are meaningless in growing children and adolescents unless considered as part of the entire growth history of the child. People come in all shapes and sizes and children grow in fits and spurts, sometimes reaching a higher BMI, before growing in height and settling into a lower BMI, or vice versa.

I have looked at the Fitnessgram website to get a better idea of the program, and I do appreciate how they have attempted to come up with an alternative scale for measuring physical fitness apart from BMI alone. Nevertheless, BMI’s are still being calculated and reported directly to students for the purpose of assessing their individual health and fitness.

I have no objections to teaching kids about good nutrition and the benefits of exercise on a general level. I also have no problem with challenging kids to work on and improve the number of sit-ups they can do, or their time for running a mile, etc. over the course of a semester.

I do see a problem with screening kids (no matter how private the setting), assigning them some level of “health” status and giving them a report that prescribes a personalized health intervention without the input of a physician or the consent of parents.
The example reports I saw on the Fitness Gram website do list height, weight and BMI along with their “Fitness Zone” number. I believe that no matter how good the computer model may be, or how broad the “healthy zone” is, there will still be kids who will look at these results, and at the weight/BMI data on their reports and feel dissatisfied with their bodies, and want to try and change their bodies, possibly through unhealthy weight control practices.

I would also argue that kids are naturally competitive, curious, and in this day and age, overly-sensitized to issues of overweight/high BMI. They are not just going to look at the Healthy Zone number and be satisfied with that as a measure of fitness. Friends will invariably ask each other what their other measurements were and make comparisons. Some of this information will be overheard, passed on, and/or misinterpreted and used as fodder for bullying, whether a particular child is in the “fit zone” or not.

As for kids with eating disorders, I can tell you, from personal experience and from my work with families of children with eating disorders, that any type of weigh-in can provoke extreme anxiety in a patient still in the grips of an ED. Some treatment protocols for eating disorders do not let patients know their weights until they are well on their way to recovery. I have heard many families recall how their child’s progress was set back for weeks after the child inadvertently found out his/her weight.

I am dismayed to hear that this program is being mandated in many states. I do understand that the majority of kids will not be harmed by this kind of intervention and some may even be helped by it. I simply believe that schools should not be in the business of doing individual health assessments and that any such interventions should be explained to parents in advance with the option to opt their child out of the whole exercise. I believe that before any school implements this type of program they should seriously consider the following questions:

Is school really the right place for individual health assessments and interventions?

Can the goals of the Health and PE programs (such as teaching healthy behaviors and measuring improvements in fitness levels) be achieved without a body composition assessment?

Can you teach about the limitations of BMI and find ways to promote positive body image without measuring individuals?

Does substituting “body composition” for “BMI” really change many of the concerns that the CDC, AHA and the EDC have regarding individual body size screenings?

Thank you for hearing me out on this. I do not believe I am alone in my feelings about this issue and that other parents would like the opportunity to evaluate this program and decide for themselves whether to have their children participate.

Sincerely,

A Concerned Parent

References:

From the American Heart Association“Policy Position Statement on Body Mass Index (BMI) Surveillance and Assessment in Schools”
http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_301789.pdf

"The American Heart Association does not recommend BMI assessment programs used for individual health screening purposes unless there is careful consideration of privacy issues, adequate training, measurement techniques, parental notification, adequate evaluation, and the importance of linking families/caregivers with resources in the community."

From the Eating Disorder Coalition"Why is mandatory BMI reporting a bad idea?
http://www.eatingdisorderscoalition.org/documents/TalkingpointsBMI.pdf

No research basis. Currently virtually no data is available on the efficacy of this policy. Will it have a positive impact on children’s weight and help reduce obesity in the nation? Or could it actually have negative consequences? Without evidence of its merits we fear this policy will do harm.Redundant and inappropriate. The American Academy of Pediatrics offers guidelines to practicing pediatricians that they track BMIs as part of their routine health care. The standard practice for pediatricians is to measure a child’s body weight upon yearly examinations. Pediatricians are trained to not only do this appropriately but also to professionally advise parents and children if BMI rates rise significantly. The doctor’s office is the appropriate environment for measuring weight not the schools.Information without meaningful strategies. The public is bombarded with contradictory information about healthy eating, healthy weight and effective strategies for weight loss daily. How do parents navigate all this data and properly guide their children? Some parents may focus on the child’s weight as another important arena for achievement and encourage diets and other weight loss strategies that could inadvertently be harmful. Mandatory BMI reporting forces parents to walk the fine line between encouraging healthy eating and risky weight loss strategies that can put the child at risk for developing negative body image and eating disorder symptoms.Could do harm. While there is no data to suggest mandatory BMI reporting would result in positive outcomes, there is research to suggest that it could in fact do harm. A focus on weight often has a boomerang effect. The area of athletics is a prime example. When body weight is emphasized as a criteria for determining success in sports (such as wrestling, gymnastics or ballet), we see a higher prevalence of people with eating disordered behaviors and an adverse impact on performance.Puts people at risk for the development of eating disorders. Individuals simply told they are too fat can be at risk for using dangerous weight loss strategies such as the use of amphetamines, intestinal bypass, fasting, very low calorie diets, laxatives, purging, etc. Such dangerous weight loss strategies are associated with negative health outcomes including death. Restrictive dieting can lead to decreased cognitive performance, negative body image, depression, binge behavior and the onset of eating disorders. Anorexia has the highest mortality rate of all the psychiatric disorders.Puts people at risk for bullying and teasing.Bullying has become an increasingly notable problem for schools and parents alike. BMI reporting is likely to promote fat-related stigma where children are at risk for being called names such as “fatty, fat girl, lardo,” and so on. Research shows that being fat is a common reason for taunting and teasing."

From the US Center for Disease Control (CDC)"BMI Executive Summary"
http://www.cdc.gov/HealthyYouth/obesity/bmi/pdf/BMI_execsumm.pdf

“A number of concerns have been expressed about school-based BMI screening programs, including that they might stigmatize students and lead to harmful behaviors. Other concerns are that these programs might be ineffective, waste scarce health promotion resources, and distract attention from other school-based obesity prevention activities. More research is needed to assess the validity of these concerns. BMI surveillance programs are less controversial, because they do not involve the communication of sensitive information to parents and do not require individualized follow-up care for students identified to be at risk. Schools that initiate BMI measurement programs should have in place a safe and supportive environment for students of all body sizes and a comprehensive set of science-based strategies to promote physical activity and healthy eating. In addition, BMI screening programs should ensure that parents receive a clear and respectful explanation of the BMI results and appropriate follow-up actions; and that resources are available for safe and effective follow-up. To reduce the risk of harming students, BMI measurement programs should adhere to the following safeguards:(1) introduce the program to school staf and community members and obtain parental consent, (2) train staff in administering the program (ideally, implementation will be led by a highly qualified staff member, such as the school nurse), (3) establish safeguards to protect student privacy, (4) obtain and use accurate equipment, (5) accurately calculate and interpret the data, (6) develop eicient data collection procedures, (7) avoid using BMI results to evaluate student or teacher performance, and (8) regularly evaluate the program and its intended outcomes and unintended consequences.”

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